News Flash: CRT Is Still Not DME

My first reaction to the news of Medicare’s latest capped-rental proposed rule was not politically correct. In the middle of the hallway in the middle of the work day, I called out to my office-mates, “Great news! Science must have figured out a way to regenerate brain cells and spinal cords, because CMS now says our consumers need their equipment for just eight months each!”

No one looked up — they’re pretty accustomed to my occasional funding rant — so I was left muttering to myself along the lines of “Why is CMS (aka, the Centers for Medicare & Medicaid Services) always picking on my people (aka, you and your clients)?”

After cooling off enough to pick through the complex rehab technology-relevant sections of the 186-page proposed rule, I’d had a slight change of heart.

To be sure, this latest capped-rental proposal from CMS would be a migraine for CRT providers: Instead of paying a lump sum for many types of equipment it purchases for beneficiaries, Medicare wants to pay providers in 13 monthly installments — which would wreak havoc with providers’ cash flows. CMS quotes huge anticipated savings under this new plan: $20 million in each of the next three years, $30 million in 2017, etc.

But as Rita Hostak, Sunrise Medical’s VP of government relations, pointed out during an interview, those savings are based on CMS data that says Medicare beneficiaries use their DME for only eight months on average — the implication being that after that period, the beneficiary either recovers enough to no longer need the equipment, or passes away.

Neither scenario applies to the average Medicare beneficiary using CRT. Unfortunately, the sorts of diagnoses that CRT users have — predominantly cerebral palsy and brain injuries among adults, and brain injuries or developmental delays for pediatric beneficiaries, according to data collected by NCART, Hostak says — do not heal. But neither do we generally expect beneficiaries with CP or brain injuries to have drastically shortened lifespans.

“When you’re talking about wheelchairs for people with permanent disabilities and pediatric wheelchairs, these people are not end-of-life,” Hostak says. “They’re not even sick! They just have a disability and need the technology to allow them to be more functional and independent.”

If saving money is the goal, it makes sense that CMS wants to make eight monthly payments instead of paying full price outright for many kinds of equipment. What doesn’t make sense is why CMS keeps saying, “Eight months.”

And that’s where my change of heart came in.

Clearly, when CMS says beneficiaries use their DME for an average of just eight months, it isn’t talking about CRT consumers. It’s referring to seniors who have recoverable conditions — surgery that requires a standard wheelchair for a couple of months, for example — or to seniors who are medically very frail.

And when CMS is talking about DME, it’s not talking about CRT. Or at least, it shouldn’t be referring to CRT.

This isn’t the first time that CRT has been caught up — possibly inadvertently — in the larger DME net. It happened with competitive bidding, and it’s happened with this capped-rental proposed rule. It will surely keep happening until CRT gets its own benefit category that takes into account the types of diagnoses that beneficiaries have, and their prognoses, and how customized their equipment has to be.

There are two bills in Congress right now, one in each chamber, that would emphatically and formally define those differences. CRT doesn’t belong within DME because it’s not DME. So instead of complaining in my office hallways, I’ve got a couple of phone calls to make.

This article originally appeared in the September 2013 issue of Mobility Management.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.